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1.
Arq. bras. neurocir ; 41(1): 43-50, 07/03/2022.
Article in English | LILACS | ID: biblio-1362077

ABSTRACT

Introduction Intracranial aneurysm (IA) is a major healthcare concern. The use of statin to reduce serum cholesterol has shown evidence to reduce cardiovascular risk in various diseases, but the impact on IA has not been described. This study aims to determine whether statin use, and serum cholesterol levels interfere with outcomes after IA event. Methods A cohort of patients with IA was analyzed. Patients social and demographics data were collected.Modified Rankin scale (mRS) score after 6months of follow-up was the endpoint. The data regarding statins use, presence or not of atherosclerotic plaque in radiological images and serum cholesterol of 35 patients were included in our study. Linear regression models were used to determine the influence of those 6 variables in the clinical outcome. Results The prevalence of atherosclerotic plaque, high cholesterol and use of statins was 34.3%, 48.5%, and 14.2%, respectively. Statins and serum cholesterol did not impact the overall outcome,measured by mRS after 6 months (p>0.05), but did show different tendencies when separated by IA rupture status. Serum cholesterol shows na important association with rupture of aneurysm (p»0.0382). High cholesterol and use of statins show a tendency for worse outcome with ruptured aneurysm, and the opposite is true for unruptured aneurysm. The presence of atherosclerotic plaques was not related with worse outcomes. Conclusions Multiple and opposite mechanisms might be involved in the pathophysiology of IA. Ruptured aneurysms are associated with higher levels of serum cholesterol. Serum cholesterol and statins use were not correlated with worse outcomes, but further studies are important to clarify these relationships.


Introdução Aneurisma intracranial (AI) é uma grande preocupação para a saúde. Evidências apontam que o uso de estatina para reduzir o colesterol sérico diminui o risco cardiovascular em diversas doenças, mas o impacto em AI ainda não foi descrito. Este estudo almeja determinar se o uso de estatina e o nível sérico de colesterol interferem no desfecho clínico após a ocorrência de AIs. Métodos Uma coorte de pacientes com AI foi analisada. Os dados sociodemográficos dos pacientes foram coletados. Ao final de 6 meses de acompanhamento, aplicou-se a escala modificada de Rankin (mRS). Os dados sobre uso de estatina, existência de placa aterosclerótica em imagens radiológicas, e colesterol sérico de 35 pacientes foram incluídos no estudo. Modelos de regressão linear foram usados para determinar a influência dessas 6 variáveis nos desfechos clínicos. Resultados A prevalência de placa aterosclerótica, colesterol elevado, e uso de estatina foram respectivamente 34,3%, 48,5% e 14,2%. Estatina e colesterol sérico não impactaram nos desfechos medidos pela mRS em 6 meses (p > 0,05), mas mostraram diferentes tendências quando separados pelo estado de ruptura do AI. Colesterol sérico apresenta uma importante associação com ruptura de aneurisma (p » 0,0382). Colesterol elevado e uso de estatinas representam uma tendência a piores desfechos para aneurismas rompidos, e o oposto é verdade para os não rompidos. A presença de placa aterosclerótica não está relacionada com piores resultados. Conclusões Mecanismos múltiplos e opostos podem estar envolvidos na patofisio logia do AI. Aneurismas rompidos estão associados com maiores níveis de colesterol sérico. Colesterol sérico e estatinas não foram correlacionados com piores desfechos, mas mais estudos são importantes para clarificar a relação entre esses fatores


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Intracranial Aneurysm , Cholesterol/analysis , Hydroxymethylglutaryl-CoA Reductase Inhibitors/analysis , Plaque, Atherosclerotic/epidemiology , Linear Models , Cohort Studies , Data Interpretation, Statistical
3.
Rev. bras. oftalmol ; 81: e0065, 2022. graf
Article in Portuguese | LILACS | ID: biblio-1407669

ABSTRACT

RESUMO Os aneurismas intracranianos são dilatações em segmentos arteriais que irrigam o sistema nervoso central. Acometem 2% da população e as alterações oftalmológicas podem ser as primeiras manifestações do quadro. O objetivo deste relato foi descrever um caso de aneurisma de artéria carótida interna que cursou com restrição da movimentação ocular, alteração do reflexo fotomotor, ptose palpebral, dor facial e cervical. O diagnóstico foi confirmado pela identificação do aneurisma por meio do exame de angiografia cerebral. Foi realizado teste de oclusão por balão, cujo resultado positivo possibilitou a oclusão total da artéria carótida interna por meio de ligadura cirúrgica, procedimento este realizado com sucesso.


ABSTRACT Intracranial aneurysms are dilations in segments of the arteries that irrigate the central nervous system. They affect 2% of the population and the ophthalmologic disorders may be the first evidence in the clinical examination. The aim of the report is to describe a case of an internal carotid artery aneurysm that showed restrictions of ocular movements, change of pupillary light reflex, palpebral ptosis, facial, and cervical pain. This diagnosis was confirmed by the identification of the aneurysm through angiography. A balloon occlusion test was performed, and its positive result made a complete occlusion of the Internal Carotid Artery possible through surgery ligation, procedure that was successful.


Subject(s)
Humans , Female , Aged , Blepharoptosis/etiology , Carotid Artery Diseases/complications , Carotid Artery, Internal/pathology , Intracranial Aneurysm/complications , Ophthalmoplegia/etiology , Facial Pain/etiology , Cerebral Angiography , Carotid Artery Diseases/surgery , Carotid Artery Diseases/diagnostic imaging , Carotid Artery, Internal/surgery , Carotid Artery, Internal/diagnostic imaging , Tomography, X-Ray Computed , Intracranial Aneurysm/surgery , Intracranial Aneurysm/diagnostic imaging , Neck Pain/etiology , Balloon Occlusion
4.
Epidemiol. serv. saúde ; 31(2): e20211122, 2022. tab
Article in English, Portuguese | LILACS | ID: biblio-1404726

ABSTRACT

Objetivo: Analisar internações para tratamento de aneurismas cerebrais rotos e não rotos com realização de embolização e de microcirurgia cerebral no Sistema Único de Saúde (SUS), Brasil, 2009-2018. Métodos: Estudo descritivo, utilizando dados do Sistema de Informações Hospitalares do SUS. Descreveu-se a frequência das internações, procedimentos, utilização de unidade de tratamento intensivo (UTI), letalidade e gastos. Resultados: Das 43.927 internações, 22.622 (51,5%) resultaram em microcirurgia. Embolização e microcirurgia foram mais frequentes no sexo feminino. A duração das internações com embolização foi de 7,7 dias (±9,0), e com microcirurgia, 16,2 (±14,2) dias, a frequência de admissão em UTI, 58,6% e 85,3%, e a letalidade, 5,9% e 10,9%, respectivamente. Do gasto total, US$ 240 milhões, 66,3% corresponderam às internações com embolização. Conclusão: As internações com embolização para tratamento de aneurismas cerebrais no SUS apresentaram menor duração, menor frequência de utilização de UTI e menor letalidade, porém maior gasto em relação à microcirurgia cerebral.


Objetivo: Analizar las internaciones para tratamiento de aneurismas cerebrales rotos y no rotos en cuanto a embolización y microcirugía cerebral en el Sistema Único de Salud (SUS), Brasil, de 2009 a 2018. Métodos: Estudio descriptivo utilizando datos del Sistema de Información Hospitalaria (SIH)/SUS relacionados con la frecuencia de hospitalizaciones, procedimientos, uso de la unidad de cuidados intensivos (UCI), letalidad y gastos. Resultados: De los 43.927 ingresos, 22.622 (51,5%) correspondieron a microcirugía. Hubo una mayor frecuencia de procedimientos de embolización y microcirugía entre las personas del sexo femenino. De las hospitalizaciones con embolización y microcirugía, respectivamente, la duración de la estadía fue de 7,7 (±9,0) y 16,2 (±14,2) días, la frecuencia de ingreso en la UCI fue del 58,6% y el 85,3% y la letalidad del 5,9% y el 10,9%. El gasto total fue de US$ 240 millones, de los cuales el 66,3% correspondió a hospitalizaciones con embolización. Conclusión: Las hospitalizaciones con embolización, para el tratamiento de aneurismas cerebrales en el SUS, tuvieron menor tiempo de estadía, menor frecuencia de uso de la UCI y menor letalidad, pero mayores gastos en relación a la microcirugía cerebral.


Objective: To analyze hospital admissions for treatment of ruptured and unruptured cerebral aneurysms with embolization and brain microsurgery performed within the Brazilian National Health System (SUS), 2009-2018. Methods: This was a descriptive study, using data from the SUS's Hospital Information System. Frequency of hospital admissions, procedures, use of intensive care unit (ICU), case fatality ratio and expenditures were described. Results: Of the 43,927 hospital admissions, 22,622 (51.5%) resulted in microsurgery. Embolization and cerebral microsurgery were more frequent among females. Length of hospital stay with embolization procedure was 7.7 days (±9.0), and with microsurgery, 16.2 (±14.2) days, frequency of ICU admission, 58.6% and 85.3%, and case fatality ratio, 5.9% and 10.9% respectively. Of the total expenditure, USD 240 million, 66.3% corresponded to hospitalizations with embolization procedure. Conclusion: Hospital admissions with embolization procedure for treatment of cerebral aneurysms within the SUS showed a shorter length of stay, less frequent use of ICU and lower case fatality ratio, but higher expenditure when compared to brain microsurgery.


Subject(s)
Subarachnoid Hemorrhage/therapy , Intracranial Aneurysm , Intracranial Aneurysm/therapy , Unified Health System , Brazil , Hospitalization
5.
Acta cir. bras ; 37(1): e370107, 2022. ilus, tab, graf
Article in English | LILACS, VETINDEX | ID: biblio-1413349

ABSTRACT

Purpose: To analyze the role of serum creatinine levels as a biomarker of intracranial aneurysm outcomes. Methods: This is a prospective analysis of outcomes of patients with intracranial aneurysm. One hundred forty-seven patients with serum creatinine at admission and 6 months follow up were included. Linear and logistic regressions were used to analyze the data. Modified Rankin scale (mRS) was used to assess outcome. Results: Creatinine level was not directly related to aneurysm outcome nor aneurysm rupture (p > 0.05). However, patients with a glomerular filtration rate (GFR) lower than 72.50 mL·min­1 had an odds ratio (OR) of 3.049 (p = 0.006) for worse outcome. Similarly, aneurysm rupture had an OR of 2.957 (p = 0.014) for worse outcomes. Stepwise selection model selected 4 variables for outcomes prediction: serum creatinine, sex, hypertension and treatment. Hypertensive patients had, on average, an increase in 0.588 in mRS (p = 0.022), while treatment with microsurgery had a decrease in 0.555 (p = 0.038). Conclusions: Patients with higher GFR had better outcomes after 6 months. Patients with higher GFR had better outcomes after 6 months. Creatinine presented an indirect role in GFR values and should be included in models for outcome prediction.


Subject(s)
Humans , Intracranial Aneurysm/prevention & control , Creatinine/analysis , Glomerular Filtration Rate , Linear Models
6.
Article in Chinese | WPRIM | ID: wpr-941047

ABSTRACT

OBJECTIVE@#To investigate the impact of postoperative serious cardiovascular adverse events (CAE) on outcomes of patients undergoing craniotomy for intracranial aneurysm clipping.@*METHODS@#This retrospective cohort study was conducted among the patients undergoing craniotomy for intracranial aneurysm clipping during the period from December, 2016 to December, 2017, who were divided into CAE group and non-CAE group according to the occurrence of Clavien-Dindo grade ≥II CAEs after the surgery. The perioperative clinical characteristics of the patients, complications and neurological functions during hospitalization, and mortality and neurological functions at 1 year postoperatively were evaluated. The primary outcome was mortality within 1 year after the surgery. The secondary outcomes were Glasgow outcome scale (GOS) score at 1 year, lengths of postoperative hospital and intensive care unit (ICU) stay, and Glasgow coma scale (GCS) score at discharge.@*RESULTS@#A total of 361 patients were enrolled in the final analysis, including 20 (5.5%) patients in CAE group and 341 in the non-CAE group. No significant differences were found in the patients' demographic characteristics, clinical history, or other postoperative adverse events between the two groups. The 1-year mortality was significantly higher in CAE group than in the non-CAE group (20.0% vs 5.6%, P=0.01). Logistics regression analysis showed that when adjusted for age, gender, emergency hospitalization, subarachnoid hemorrhage, volume of bleeding, duration of operation, aneurysm location, and preoperative history of cardiovascular disease, postoperative CAEs of Clavien-Dindo grade≥II was independently correlated with 1-year mortality rate of the patients with an adjusted odds ratio of 3.670 (95% CI: 1.037-12.992, P=0.04). The patients with CEA also had a lower GOS score at 1 year after surgery than those without CEA (P=0.002). No significant differences were found in the occurrence of other adverse events, postoperative hospital stay, ICU stay, or GCS scores at discharge between the two groups (P > 0.05).@*CONCLUSION@#Postoperative CAEs may be a risk factor for increased 1-year mortality and disability in patients undergoing craniotomy for intracranial aneurysms.


Subject(s)
Craniotomy/adverse effects , Humans , Intracranial Aneurysm/surgery , Postoperative Period , Retrospective Studies , Subarachnoid Hemorrhage/surgery , Treatment Outcome
7.
Arq. bras. neurocir ; 40(4): 374-379, 26/11/2021.
Article in English | LILACS | ID: biblio-1362107

ABSTRACT

Objective To report three cases of vein of Galen aneurysmalmalformation (VGAM) in pediatric patients treated at the hemodynamics lab of Hospital Santa Isabel (HSI) in Blumenau, state of Santa Catarina, Brazil, from 2006 to 2020. Clinical presentation, endovascular treatment, and postprocedure evolution to date are included. Case description Three children aged 5 to 12 months with cardiac, respiratory, or neurological damage in the neonatal stage, were referred to the neurosurgery service and diagnosed with VGAM. The three patients underwent endovascular embolization of themalformation, with different clinical evolution throughout outpatient follow-up. Conclusion Vein of Galen aneurysmal malformations are uncommon vascular abnormalities that, until the advent of endovascular embolization, were associated with high morbidity and mortality rates. Its prognosis is linked with initial clinic, early diagnosis, and timely surgical correction.


Subject(s)
Humans , Male , Female , Infant , Intracranial Aneurysm/surgery , Vein of Galen Malformations/surgery , Vein of Galen Malformations/physiopathology , Endovascular Procedures/methods , Prognosis , Intracranial Aneurysm/diagnostic imaging , Treatment Outcome , Embolization, Therapeutic/methods , Vein of Galen Malformations/diagnostic imaging
8.
Arq. bras. neurocir ; 40(4): 339-348, 26/11/2021.
Article in English | LILACS | ID: biblio-1362079

ABSTRACT

Introduction The middle meningeal artery (MMA) is an important artery in neurosurgery. As the largest branch of the maxillary artery, it provides nutrition to the meninges and to the frontal and parietal regions. Diseases, including dural arteriovenous fistula (DAVF), pseudoaneurysm, true aneurysm, traumatic arteriovenous fistula (TAVF), Moya-Moya disease (MMD), recurrent chronic subdural hematoma (CSDH), migraine, and meningioma,may be related to the MMA. The aim of the present study is to describe the anatomy of the MMA and to correlate it with brain diseases. Methods A literature review was performed using the PubMed, Scielo, Scientific Direct, Ebsco, LILACS, TripDataBase and Cochrane databases, with the following descriptors: neurosurgery, neuroanatomy, meninges and blood supply. Discussion The MMA is embedded in a cranial groove, and traumatic or iatrogenic factors can result in MMA-associated pseudoaneurysms or arteriovenous fistulas (AVFs). In hemodynamic stress, true aneurysms can develop. Arteriovenous fistulas, pseudoaneurysms, and true aneurysms can be effectively treated by endovascular or surgical removal. In MMD, the MMA plays a role in the development and in the improvement of collateral circulation. Finally, in cases of CSDH, when standard surgery and drainage fail, MMA embolization can constitute a great alternative. Conclusion The MMA is a relevant structure for the understanding of neurosurgical diseases. In conclusion, every neurosurgeon must know the anatomy of the MMA sufficiently to correlate it with the diagnosed pathology, thus obtaining treatment effectiveness and preventing brain lesion.


Subject(s)
Craniocerebral Trauma/surgery , Meningeal Arteries/anatomy & histology , Meningeal Arteries/physiopathology , Intracranial Aneurysm/complications , Arteriovenous Fistula/surgery , Aneurysm, False/surgery , Embolization, Therapeutic/methods
9.
Cambios rev. méd ; 20(2): 5-11, 30 Diciembre 2021. tabs.
Article in Spanish | LILACS | ID: biblio-1368176

ABSTRACT

INTRODUCCIÓN. En Ecuador, las enfermedades cerebrovasculares son la tercera causa de muerte en la población general; existen pocos datos en la literatura médica sobre la hemorragia subaracnoidea aneurismática y aneurismas no rotos, por lo que fue fundamental describir un perfil clínico. OBJETIVO. Caracterizar la clínica de los pacientes con diagnóstico de aneurisma cerebral. MATERIALES Y MÉTODOS. Estudio observacional descriptivo. Población de 450 y muestra de 447 pacientes con diagnóstico de aneurisma cerebral atendidos en la Unidad de Neurología del Hospital Carlos Andrade Marín, periodo enero 2010 a diciembre 2018. Los datos clínicos e imagenológicos fueron recolectados a través de la revisión de historias clínicas digitales obtenidas del sistema informático MIS/AS400, y se analizaron en el programa estadístico International Business Machines Statistical Package for the Social Sciences, versión 23. RESULTADOS. Se identificaron 605 aneurismas en 447 pacientes. El 80,5% (360; 447) presentó aneurismas rotos, de éstos el 81,4% (293; 360) tuvo un solo aneurisma. El factor de riesgo más frecuente fue la hipertensión arterial con el 44,3% (198; 447), las manifestaciones observadas fueron: hemorragia subaracnoidea con el 98,9% (356; 360) en aneurismas rotos; y cefalea con el 65,5% (57; 87) en aneurismas no rotos. DISCUSIÓN. Se encontró datos relevantes no coincidentes con la literatura científica mundial, como el bajo número de aneurismas asintomáticos y no rotos, comparados con su contraparte. CONCLUSIÓN. Se evidenció que los aneurismas intracraneales produjeron una amplia gama de manifestaciones clínicas, que fluctuaron desde la hemorragia subaracnoidea como la más frecuente en el grupo de aneurismas rotos, hasta pacientes completamente asintomáticos en el grupo de aneurismas no rotos.


INTRODUCTION. In Ecuador, cerebrovascular diseases are the third leading cause of death in the general population; there are few data in the medical literature on aneurysmal subarachnoid hemorrhage and unruptured aneurysms, so it was essential to describe a clinical profile. OBJECTIVE. To characterize the clinical profile of patients diagnosed with cerebral aneurysm. MATERIALS AND METHODS. Descriptive observational study. Population of 450 and sample of 447 patients with a diagnosis of cerebral aneurysm seen in the Neurology Unit of the Carlos Andrade Marín Hospital, period January 2010 to December 2018. Clinical and imaging data were collected through the review of digital medical records obtained from the MIS/AS400 computer system, and were analyzed in the statistical program International Business Machines Statistical Package for the Social Sciences, version 23. RESULTS. A total of 605 aneurysms were identified in 447 patients. A total of 80,5% (360; 447) had ruptured aneurysms, of which 81,4% (293; 360) had a single aneurysm. The most common risk factor was hypertension with 44,3% (198; 447), the manifestations observed were: subarachnoid hemorrhage with 98,9% (356; 360) in ruptured aneurysms; and headache with 65,5% (57; 87) in unruptured aneurysms. DISCUSSION. We found relevant data not consistent with the world scientific literature, such as the low number of asymptomatic and unruptured aneurysms, compared with its counterpart. CONCLUSION. It was evidenced that intracranial aneurysms produced a wide range of clinical manifestations, ranging from subarachnoid hemorrhage as the most frequent in the group of ruptured aneurysms, to completely asymptomatic patients in the group of unruptured aneurysms.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Subarachnoid Hemorrhage , Intracranial Aneurysm , Aneurysm, Ruptured , Headache , Aneurysm , Neurology , Angiography, Digital Subtraction , Cerebral Arterial Diseases , Statistics, Nonparametric , Ecuador , Hemorrhagic Stroke , Hypertension
11.
Arq. bras. neurocir ; 40(3): 288-293, 15/09/2021.
Article in English | LILACS | ID: biblio-1362169

ABSTRACT

Virtual reality (VR) has increasingly been implemented in neurosurgical practice. A patient with an unruptured anterior communicating artery (AcoA) aneurysm was referred to our institution. Imaging data from computed tomography angiography (CTA) was used to create a patient specific 3D model of vascular and skull base anatomy, and then processed to a VR compatible environment. Minimally invasive approaches (mini-pterional, supraorbital and mini-orbitozygomatic) were simulated and assessed for adequate vascular exposure in VR. Using an eyebrow approach, aminiorbitozygomatic approach was performed, with clip exclusion of the aneurysm from the circulation. The step-by-step process of VR planning is outlined, and the advantages and disadvantages for the neurosurgeon of this technology are reviewed.


Subject(s)
Humans , Female , Middle Aged , Intracranial Aneurysm/surgery , Minimally Invasive Surgical Procedures/methods , Simulation Training/methods , Virtual Reality , Cardiovascular Surgical Procedures/methods , Intracranial Aneurysm/diagnostic imaging
12.
Arq. neuropsiquiatr ; 79(9): 759-765, Sept. 2021. tab, graf
Article in English | LILACS | ID: biblio-1345343

ABSTRACT

ABSTRACT Background: Predictors of outcomes following endovascular treatment (ET) for aneurysmal subarachnoid hemorrhage (aSAH) are not well-defined. Identifying them would be beneficial in determining which patients might benefit from ET. Objective: To identify the predictive factors for poor outcomes following ET for aSAH. Methods: 120 patients with ruptured cerebral aneurysms underwent endovascular embolization between January 2017 and December 2018. Blood pressure variability was examined using the standard deviation of the 24-hour systolic blood pressure (24hSSD) and 24-hour diastolic blood pressure (24hDSD). Predictors were identified through univariate and multivariate regression analysis. All patients were followed up for three months. Results: At follow-up, 86 patients (71.7%) had good outcomes and 34 (28.3%) had poor outcomes. Patients with poor outcomes had significantly higher 24hSSD than those with good outcomes (19.3 ± 5.5 vs 14.1 ± 4.8 mmHg; P < 0.001). The 24hDSD did not differ significantly between patients with good outcomes and those with poor outcomes (9.5 ± 2.3 vs 9.9 ± 3.5 mmHg; P = 0.464). The following were significant risk factors for poor outcomes after endovascular embolization: age ≥ 65 years (odds ratio [OR] = 23.0; 95% confidence interval [CI]: 3.0-175.9; P = 0.002); Hunt-Hess grade 3-4 (OR = 6.8; 95% CI: 1.1-33.7; P = 0.039); Fisher grade 3-4 (OR = 47.1; 95% CI: 3.8-586.5; P = 0.003); postoperative complications (OR = 6.1; 95% CI: 1.1-34.8; P = 0.042); and 24hSSD ≥ 15 mmHg (OR = 14.9; 95% CI: 4.0-55.2; P < 0.001). Conclusion: Elevated 24hSSD is a possibly treatable predictive factor for poor outcomes after ET for aSAH.


RESUMO Antecedentes: Fatores preditores de resultados após tratamento endovascular (TE) para hemorragia subaracnóide aneurismática (HSA) não estão bem definidos. Identificá-los seria útil para determinar quais pacientes podem se beneficiar de TE. Objetivo: Identificar os fatores preditivos de resultados ruins após TE para HSA. Métodos: 120 pacientes com aneurismas cerebrais rompidos foram submetidos à embolização endovascular entre janeiro de 2017 e dezembro de 2018. A variabilidade da pressão arterial foi examinada usando-se o desvio padrão da PA sistólica de 24 horas (DPPAS- 24h) e da PA diastólica de 24 horas (DPPAD-24h). Os fatores preditores foram identificados por meio de análises de regressão univariada e multivariada. Todos os pacientes foram acompanhados por três meses. Resultados: No acompanhamento, 86 pacientes (71,7%) tiveram bons resultados e 34 (28,3%) tiveram resultados ruins. Pacientes com resultados ruins apresentaram DPPAS-24h significativamente maior do que aqueles com bons resultados (19,3 ± 5,5 vs 14,1 ± 4,8 mmHg; P <0,001). O DPPAD-24h não diferiu significativamente entre os pacientes com bons resultados e aqueles com resultados ruins (9,5 ± 2,3 vs 9,9 ± 3,5 mmHg; P = 0,464). Os fatores de risco significativos para resultados ruins após embolização endovascular foram os seguintes: idade ≥ 65 anos (razão de probabilidade [OR] = 23,0; intervalo de confiança de 95% [IC]: 3,0-175,9; P = 0,002); escala de Hunt-Hess 3-4 (OR = 6,8; IC 95%: 1,1-33,7; P = 0,039); escala de Fisher 3-4 (OR = 47,1; IC 95%: 3,8-586,5; P = 0,003); complicações pós-operatórias (OR = 6,1; IC 95%: 1,1-34,8; P = 0,042); e DPPAS 24h ≥ 15 mmHg (OR = 14,9; IC 95%: 4,0-55,2; P <0,001). Conclusão: O DPPAS 24h elevado é um fator preditivo possivelmente tratável para resultados ruins após TE para HSA.


Subject(s)
Humans , Aged , Subarachnoid Hemorrhage/therapy , Intracranial Aneurysm/complications , Intracranial Aneurysm/therapy , Blood Pressure , Retrospective Studies , Treatment Outcome
13.
Rev. argent. neurocir ; 35(3): 290-291, sept. 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1427072

ABSTRACT

La amable invitación a escribir este artículo me llevó al interesante ejercicio de reflexionar sobre qué hago y cómo enfrento a un paciente que llega a la consulta derivado con un aneurisma cerebral incidental: día normal en el consultorio, tratar de resolver en forma simple problemas que son com-plejos.Como en toda consulta primero hay que escuchar y hacerse la idea de cómo viene el paciente, si está asustado, si muestra buena predisposición ¿Pregunta tranquilo qué hacer después de un hallazgo inesperado o llega desconfiado, de consulta en consulta, buscando definiciones u opiniones acerca de un aneurisma que le han encontrado en un estudio por una cefalea poco clara?Comprendo la ansiedad y la incertidumbre que genera la noticia. Ponerlo en contexto general a veces ayuda: 3 al 5% de la población tiene aneurismas cerebrales, la mayoría pequeños y la posibilidad de un sangrado es del 1% anual o menos


Subject(s)
Aneurysm , Patients , Intracranial Aneurysm , Neurosurgeons
14.
Rev. argent. neurocir ; 35(2): 107-115, jun. 2021. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1398028

ABSTRACT

Intoducción: El tratamiento microquirúrgico para los aneurismas intracraneales es el clipado, sin embargo, algunos aneurismas deben ser resueltos mediante wrapping. El objetivo del trabajo es analizar los cambios histológicos en aneurismas fusiformes en ratas luego del wrapping con algodón natural y politetrafluoroetileno. Materiales y Método: Se trabajó con 12 Ratas Wistar divididas en 3 grupos. Luego de la anestesia se expusieron ambas arterias carótidas comunes, realizándose un aneurisma fusiforme en cada vaso. Se realizó wrapping a las carótidas derechas, grupo 1 con membrana de politetrafluoroetileno, grupo 2 con algodón natural y grupo 3 empleándo combinación de ambos materiales. Los animales fueron sacrificados a los 45 días postoperatorios, para luego procesar las muestras y análisis histológico vascular. Resultados: En el grupo 1 no se evidenciaron modificaciones estructurales, en el grupo 2 se destacó la presencia de células gigantes multinucleadas, inflamación, con infiltrado linfoplasmocitario. En el grupo 3 fue similar al grupo 2 con el agregado de metaplasia condroide y calcificaciones en capa media. Las arterias carotidas izquierdas (control) no presentaron cambios histológicos y a nivel muscular, aumento del tejido conectivo entre las fibras musculares y fibroblastos en el grupo 2. Discusión: Existen publicaciones sobre la técnica de wrapping con materiales autólogos o heterólogos. Sin embargo, no existen análisis experimentales de los efectos microestructurales producidos en las arterias tras la creación y tratamiento de un aneurisma fusiforme. Conclusiones: La combinación más efectiva para reforzar la pared del aneurisma y evitar la reacción inflamatoria circundante es la utilización de algodón natural y politetrafluoroetileno


Intoduction: The microsurgical treatment for intracranial aneurysms is clipping, however, some aneurysms must be resolved by wrapping. The objective of the work is to analyze the histological changes in fusiforms aneurysms in rats after wrapping with natural cotton and polytetrafluoroethylene. Materials and Method: We worked with 12 Wistar rats divided into 3 groups. After anesthesia, both common carotid arteries were exposed, making a fusiform aneurysm in each vessel. Right carotid wrapping was performed, group 1 with a polytetrafluoroethylene membrane, group 2 with natural cotton, and group 3 using a combination of both materials. The animals were sacrificed 45 days after surgery, to process the specimens and vascular histological analysis. Results: In group 1 there were no structural modifications, in group 2 the presence of multinucleated giant cells, inflammation, with lymphoplasmacytic infiltrate stood out. In group 3 it was similar to group 2 with the addition of chondroid metaplasia and calcifications in the middle layer. The left carotid arteries (control) did not present histological changes and at the muscle level, increased connective tissue between muscle fibers and fibroblasts in group 2. Discussion: There are publications on the wrapping technique with autologous or heterologous materials. However, there are no experimental analyzes of the microstructural effects produced in the arteries after the creation and treatment of a fusiform aneurysm. Conclusions: The most effective combination to reinforce the wall of the aneurysm and avoid the surrounding inflammatory reaction is the use of natural cotton and polytetrafluoroethylene


Subject(s)
Aneurysm , Polytetrafluoroethylene , Intracranial Aneurysm
17.
In. Fernández, Anabela. Manejo de la embarazada crítica y potencialmente grave. Montevideo, Cuadrado, 2021. p.211-227.
Monography in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1377628
18.
Article in English | AIM | ID: biblio-1366935

ABSTRACT

Primary cardiac tumors are very rare, accounting for 0,001 ­0,03% in autopsy series, cardiac myxoma (CM) account for approximately 50% of them. Association between CM and cerebral aneurysm is well documented in this condition but the occurrence of cerebral aneurysm after resection of CM is very rare, with only 40 reports in medical literature. We present a case of a 45 years old female patient with multiple cerebral aneurysms 2 years after a successful resection of cardiac myxoma, submitted to radiosurgery for 2 bigger aneurysms with good results. This report ads to literature new clinical findings and a hypothesis of radiosurgery as an effective option of treatment for cerebral aneurysms with origin in CM. Keywords: Cardiac Myxoma; Cerebral aneurysm; Radiosurgery; Neurosurgery.


Subject(s)
Humans , Intracranial Aneurysm , Radiosurgery , Myxoma , Neurosurgery
19.
Article in English | WPRIM | ID: wpr-880644

ABSTRACT

In recent years, in the absence of venous component, dilated, overlapping, and tortuous arteries forming a mass of arterial loops with a coil-like appearance have been defined as pure arterial malformation (PAM). It is extremely rare, and its etiology and treatment have not yet been fully elucidated. Here, we reported 2 cases of PAM with associated aneurysmal subarachnoid hemorrhage in this paper. Both patients had severe headache as the first symptom. Subarachnoid hemorrhage was found by CT and computed tomography angiography (CTA) and PAM with associated aneurysm was found by digital subtraction angiography (DSA). In view of the distribution of blood and the location of aneurysms, the aneurysm rupture was the most likely to be considered. Based on the involvement of the lesion in the distal blood supply, only the aneurysm was clamped during the operation. It used to be consider that PAM is safety, because of the presentation and natural history of previously reported cases. Through the cases we reported, we have doubted about "the benign natural history" and discussed its treatment. PAM can promote the formation of aneurysms and should be reviewed regularly. The surgical indications for PAM patients with aneurysm formation need to be further clarified. Management of PAM patients with ruptured aneurysm is the same as that of ruptured aneurysm. Whether there are indications needed to treat simple arterial malformations remains to be further elucidated with the multicenter, randomized controlled studies on this disease.


Subject(s)
Aneurysm, Ruptured/surgery , Angiography, Digital Subtraction , Cerebral Angiography , Humans , Intracranial Aneurysm/surgery , Subarachnoid Hemorrhage/etiology
20.
Article in Chinese | WPRIM | ID: wpr-942381

ABSTRACT

Objective: To explore the diagnosis and clinical features of internal carotid artery aneurysm in the skull base. Methods: The data of 15 patients with internal carotid aneurysms in the skull base diagnosed and treated by digital subtraction angiography (DSA) or CT angiography (CTA) in the Provincial Hospital Affiliated to Shandong First Medical University from 1995 to 2017 were collected and analyzed. Among the 15 patients, 12 were males, and 3 were females, aging from 17 to 67 years old, with a median age of 44 years. Thirteen patients were diagnosed by DSA; the other two patients were diagnosed by CTA. Thirteen patients were diagnosed with pseudoaneurysm with the first symptom of epistaxis, in which eight patients underwent head trauma and 5 underwent radiotherapy of skull base tumor. The other two patients were diagnosed with true aneurysm presented headache and cranial nerve disorder. All patients were followed up for 2 to 12 years after treatment to see whether they were cured and survived. Results: Among the eight patients with a history of trauma, five patients were cured by embolization, two patients without embolization died of massive epistaxis, one patient died of progressive cerebral infarction after embolization. Among the five patients with radiotherapy of skull base tumor, one patient died of cerebral infarction after embolization, two patients died out of the hospital due to the recurrence of the primary tumor and intracranial invasion, one patient recovered well after embolization and surgical operation, one patient gave up treatment and died of massive hemorrhage out of hospital. In the other two patients with symptom of headache, one received embolization treatment outside the hospital after receiving mistake operation, and another one gave up treatment and died due to personal reasons. In total, four patients died in hospital, four died out of the hospital, and seven patients survived. Conclusions: Internal carotid artery aneurysm is a high-risk disease of anterior and middle skull base. For patients with epistaxis with a history of trauma and radiotherapy or patients with headaches and cranial nerve disorders, the possibility of the internal carotid artery aneurysm should be considered, in which DSA or CTA examination is essentially required for ensured diagnosis and disease evaluation.. The correct diagnosis and treatment by the otolaryngologist are crucial to the prognosis of the patient.


Subject(s)
Adolescent , Adult , Aged , Carotid Artery, Internal/diagnostic imaging , Female , Humans , Intracranial Aneurysm/therapy , Male , Middle Aged , Neoplasm Recurrence, Local , Retrospective Studies , Skull Base/diagnostic imaging , Young Adult
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